Presentation on theme: "Umar Khan, MD SEACSM 2/5/2011. My arm keeps getting hurt 18 yo male football player with recurrent history of arm pain. Has been having symptoms off and."— Presentation transcript:
Umar Khan, MD SEACSM 2/5/2011
My arm keeps getting hurt 18 yo male football player with recurrent history of arm pain. Has been having symptoms off and on since Symptoms were bilateral on occasion, but usually down one arm or the other. Three years ago, playing football while tackling, contact sent symptoms of pain, numbness and weakness down both arms. Patient doesnt remember if he returned to play symptom free, however that football season, every impact he had would reproduce symptoms (down both arms or either arm). Parents noted continued weakness in his upper extremities two months after that football season. He didnt play in 2008, and in 6/2009 while cutting the grass, patient lifted up his lawnmower and had numbness and tingling down his left arm.
In 2009, he played football without any symptoms, was evaluated for the first time in 2009 before playing. 9/2010, had another episode, affecting his right arm. He initially stated this was his 1 st episode of the year, however later on repeat f/u evaluation, he admitted that he would have symptoms a few times per week, but they werent bad enough to tell anybody about it.
Unremarkable PMHx, Sx, Fam Hx, Social Hx. No meds or allergies.
Gen: WN, WD NAD lbs Neck Exam: no ttp along c-spine or paravertebral muscles, he did have ttp on his right trapezius muscle. Neck had FROM and full strength in all directions without symptoms. Spurlings test was positive reproducing symptoms on his right and causing right trapezius pain. Neuro exam: CN II-XII intact, DTRs 1+ and symmetric in his upper and lower extremities, Motor strength was 5/5 and symmetric in all 4 extremities both proximal and distal. Negative Hoffmans and inverted BR reflex.
Standard Cervical Spine X-Rays, shows no pathology except for loss of lordosis. MRI on 8/10/09: No disk bulging or protrusion present, normal vertebral body heights. No edema in the bones or spinal cord. No evidence of foraminal narrowing or spinal cord stenosis. MRI on 10/16/10: Normal cervical spine, C3-C4 level small bulging disc on the right, also some minimal disc bulging at C4-C5. No evidence of spinal stenosis. Loss of lordosis in the cervical spine. SAC 5.5mm
Sagital-diameter spinal-cord, spinal-canal, and vertebral-body diameter measurments. x = sagittal spinal-cord diameter, y = sagittal spinal-canal diameter, z = sagittal vertebral- body diameter.